RU2367388C1 - Method for treatment of vascular and dystrophic ophthalmopathies - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to ophthalmology. A specially prescribed conventional treatment regimen is combined with transcranial electrostimulation. Herewith, the conventional treatment involves introduction of 4% Taufonum 0.3-0.5 ml under conjunctiva 7-10 times; 1% Emoxipine 1-2 ml intramuscularly, 7-10 times; 10% Mildronat 0.3-0.5 ml in temple subcutaneously, 5-10 times; 10% Mildronat 4-5 ml intramuscularly, 5-8 times; Cavinton 2-4 ml in 200 ml physiologic saline, intravenously drop-by-drop, 3-7 times; 5% Mexidol 2-4 ml intramuscularly, 5-7 times; Retinalamin 0.5 ml parabulbar, 5 times, or 1 drop in each eyes prior to magnetic action 7 times. In addition, transcranial electrostimulation is performed daily for therapeutic course of 6-7 sessions, starting with current strength 0.5-1.0 mA in the first session, serially increased by 0.1-0.2 mA, considering a patient's condition.

EFFECT: method allows reducing treatment time and improving therapeutic effectiveness.

3 cl, 3 ex

Description

The invention relates to medicine and can be used in ophthalmology in the treatment of dystrophic and vascular eye diseases.

There is a method of treating dystrophic and inflammatory diseases of the posterior part of the eye by electrophoresis with nicotinic acid or enzymes (Special Physiotherapy, edited by L. Nikolayeva. Sofia, Medicine and Physical Education, 1983, p. 275-292). The course of treatment is 15-20 sessions of 10-20 minutes. However, the treatment of dystrophic and inflammatory diseases of the posterior part of the eye in a known manner is ineffective, long and laborious. Existing treatment regimens require constant correction. The duration of the courses and the low effectiveness of treatment is associated with the indirect effect of pharmacological substances on the retina of the eye. In addition, electrophoresis has a general effect on the body, so the list of contraindications for its use is quite wide.

A known method of treating vascular and dystrophic diseases of the posterior part of the eye by conducting a course of physical action on the posterior part of the eye, characterized in that the effect is carried out by diffuse-reflected laser radiation with a wavelength of 0.63-0.67 microns and an energy exposure of 1.8-6 , 4 J / m ² per session (RF Patent No. 2173120, A61F 9/00, publ. 09/10/2001). The number of fully cured patients aged 40-60 years is 83.1%, fully cured patients over 60 years of age - 68.9%. The disadvantage of this method is the lack of effectiveness of the method.

A known method of treating ischemic eye diseases through complex therapy, including antispasmodics, anticoagulants and fibrinolytics, antioxidants and decongestants (RF Patent No. 2229863, CL A61F 9/00, publ. 10.06.2004). In addition, the administration of nimotop and actovegin is prescribed, and in the acute form of the disease, nimotop is administered intravenously in an amount of 50 ml containing 10 mg of nimodipine, 1 time per day, daily, for 3 to 5 days, and actovegin is administered intravenously in an amount 500 mg per 200 ml of saline 2 times a day for 8-10 days. In the chronic form, nimotop is administered orally at 30 mg 3 times a day for 18-20 days, and Actovegin is administered intravenously in an amount of 500 mg per 200 ml of saline 1 time per day for 8-10 days.

The disadvantages of this method are the duration and limited functionality of the method.

The closest to the claimed method - the prototype - is a method of treating acute vascular optic neuropathy, including the introduction of vasodilator drugs and anticoagulants, which use caffeine, halidor, dicinone in complex treatment in a hospital for 10 days (RF Patent No. 2281071, class A61F 9/00, published on 08/10/2006). In this case, parabulbar administration of 0.3 ml of dexazone, 0.2 ml of caffeine, 0.3 ml of emoxipin is carried out sequentially, fractionally after 20 minutes once a day in combination with daily intramuscular injections 1 time per day, 2.0 ml of dicinone and 1, 0 ml of halidor and intravenous drip of haemodesis 200.0 ml on the first, third and fifth days of treatment. Also, 5 sessions of hirudotherapy are performed on the temple area every other day under the control of a coagulogram. Then, milgamma, dicinone and nootropil are administered on an outpatient basis at age dosages of 1 month.

The disadvantages of this method are the duration, lack of effectiveness and limited functionality of the method.

An object of the invention is to reduce treatment time, increase the therapeutic effectiveness of the method and expand its functionality.

The stated technical problem is achieved by the proposed method, which consists in the fact that the patient against the background of a specially selected scheme of conservative treatment undergo transcranial electrical stimulation.

Conservative treatment includes:

taufon 4%, 0.3-0.5 ml, under the conjunctiva, 7-10 times;

emoxypine 1%, 1-2 ml, IM, 7-10 times;

Mildronate 10%, 0.3-0.5 ml, under the skin of the temple, 5-10 times;

Mildronate 10%, 4-5 ml, IM, 5-8 times;

Cavinton 2-4 ml per 200 ml of saline, in / in, drip, 3-7 times;

Mexidol 5%, 2-4 ml, v / m, 5-7 times;

retinalamine 0.5 ml, parabulbarno,

5 times or magnetophoresis with retinalamine 1

a drop in both eyes before and after exposure to magnet No. 7.

As additional drugs, nootropics, metabolic and vitamin preparations selected from the group can be used:

piracetam 20%, 5 ml, v / m, 10 times;

Actovegin 5 ml, iv, 5 times;

cortexin 2 ml, v / m, 5 times;

vitamin B ₆ , 2 ml, subcutaneously, 10 times;

nicotinic acid 1%, 2 ml, v / m, 10 times;

ascorbic acid 5%, 3 ml, iv, 5-7 times.

Transcranial electrical stimulation of the protective (endorphinergic) mechanisms of the brain (TES-therapy) is carried out using the TRANSAIR-05 apparatus. The optimal value of the stimulating current is selected individually depending on the sensitivity of the patient. Starting with a current strength of 0.5-1.0 mA in the first procedure, subsequently, the current strength is increased by 0.1-0.2 mA, taking into account the patient's condition. Use a pulsed bipolar current of 0.5-2.0 mA with or without modulation, or a monopolar current of 0.5-1.5 mA. The duration of the procedure is 20-30 minutes, the course of treatment is 6-7 procedures, daily. The therapeutic effect lasts up to six months.

The introduction of a complex of drugs in the optimal mode (under the conjunctiva, under the skin of the temple, intramuscularly, intravenously) allows them to be deposited for 6-8 hours, which potentiates the pharmacodynamics of the drugs, improves the therapeutic efficacy of the treatment of vascular and degenerative eye diseases.

Emoxipin reduces capillary permeability, strengthens the vascular wall, stabilizes the cell membrane, inhibits platelet aggregation, and has antiaggregational and antihypoxic effects.

Mildronate is a metabolic agent that restores the balance between delivery and oxygen demand of cells, eliminates the accumulation of toxic metabolic products in cells, protecting them from damage, improves blood circulation in the focus of ischemia, and has a tonic effect.

Cavinton - improves cerebral circulation, cerebral metabolism and rheological properties of blood. It has a cerebroprotective effect, reduces the severity of damaging cytotoxic reactions. It stimulates brain metabolism, enhances brain absorption and absorption of glucose and oxygen, stimulates cerebral metabolism of norepinephrine and serotonin, and has an antioxidant effect. It improves microcirculation of the brain, inhibits platelet aggregation, reduces pathologically increased blood viscosity.

Mexidol - corrects the violation of the regulation systems of free-radical processes, inhibits the free radical oxidation of lipids of biomembranes, while maintaining their ordering. Reacts with peroxide radicals of peptides, increases the activity of superoxide dismutase and other antioxidant enzymes, has an antioxidant, antihypoxant, retinoprotective effect.

Retinalamin - a peptide bioregulator isolated from calves' retina, regulates the metabolism in the retina, stimulates the functions of cellular elements of the retina, improves the functional interaction of pigment epithelium and the outer segments of the photoreceptors with various retinal pathologies, enhances the activity of retinal macrophages, and has a normalizing effect on blood coagulation.

Cortexin regulates the metabolic processes in the brain and allows for fine regulation of higher nervous activity through the modulation of the metabolism of neurotransmitters and the regulation of peroxidation in neurons. In addition, cortexin increases the activity of the antioxidant system of the blood and triggers self-regulation mechanisms in the neurons of the retina.

Actovegin is a deproteinized derivative of blood plasma, contains many active substances that have a regulatory effect on the growth and function of tissue cells, activates metabolism at the cellular level. The main mechanism of action of actovegin is aimed at increasing the penetration of oxygen and glucose into cells and is manifested mainly in pathological conditions of hypoxia. Actovegin acts directly on cell metabolism by increasing the accumulation of oxygen and glucose. This inorganotropic effect ultimately leads to the optimization of the energy state of cells, due to which the metabolic state improves, especially in conditions of its insufficiency.

The drug piracetam (nootropil) has a positive effect on metabolic processes and blood circulation of the brain. Stimulates redox processes, improves regional blood flow in ischemic areas of the optic nerve and brain. Improving energy processes under the influence of piracetam leads to an increase in the stability of brain tissue during hypoxia and toxic effects.

Vitamin B ₆ and ascorbic acid accelerate regenerative processes in the nervous tissue, have antioxidant activity, regulate the conduct of a nerve impulse, affecting the transmission of excitation.

The combination of a specially selected regimen of conservative treatment and transcranial electrical stimulation allows to increase blood supply in the orbital artery pool, improve intraocular hemodynamics, as a result, metabolic processes are stimulated, and tissue trophism improves. Under the action of transcranial electrical stimulation, biological stimulation of specific cell activity (immunological, anti-inflammatory) occurs, phagocytosis intensifies, and the degree of anti-inflammatory humoral defense increases. This has a positive effect on visual function, which is manifested by an increase in visual acuity.

The invention is illustrated by the following examples of specific performance.

Example 1

The patient Berezny OA, 27 years old, medical history 214450-01, was treated at the NF FSI MNTK “Eye Microsurgery” from 09/17/07 to 09/26/07. Diagnosis: Degenerative myopia. Myopia acquired high degree, mixed, stabilized. Condition after lx ou.

Visual acuity before treatment:

OD 0.005 with 0.45 correction

OS 0.01 with a correction of 0.7

The treatment of the claimed method. Conservative treatment included: taufon 4% 0.5 ml under conjunctiva No. 7, mildronate 10% 0.3 ml under the skin of the temple No. 5, mildronate 10% 5.0 ml v / m No. 5, emoxipin 1 % 1.0 ml v / m No. 10, Cavinton 2.0 ml iv in a drop of 200 ml saline No. 7, Mexidol 5% 2.0 ml i / m No. 7, Actovegin 5.0 ml / in No. 5, ascorbic acid 5% 3.0 ml in / in No. 7, magnetophoresis with retinalamine 1 drop in both eyes before and after exposure to magnet No. 7.

Simultaneously with conservative treatment, transcranial electrical stimulation was performed on a TRANSAIR-05 apparatus using a pulsed bipolar current of 0.5 - 2.0 mA with modulation, while the first procedure set the current strength to 0.5 mA, with a subsequent increase in current at each the following procedure at 0.1-0.2 mA, given the condition of the patient. Electrodes made of silver of 999 samples with an area of at least 5 cm ^{2 were} superimposed on three points: an anode in the nose bridge directly between the eyebrows, two cathodes supramastoidally directly along the upper edge of the auricle, and were attached with adhesive plaster. The duration of the procedure is 30 minutes, the course of treatment was 6 sessions. Visual acuity after treatment:

OD 0.02 with a correction of 0.6

OS 0.04 with a correction of 0.7

Example 2

Patient Lapteva T.N., 59 years old, medical history 221911-02, was treated at the NF FSI MNTK “Eye Microsurgery” from 07.02.08 to 02.16.08. Diagnosis: Macular degeneration. Initial senile cataract. Vitreous opacification OD. Presence of a posterior chamber IOL. OS Vitreous opacification.

Visual acuity before treatment:

OD 0.15 with a correction of 0.6

OS 1.0 without correction

The treatment of the claimed method. Conservative treatment included: taufon 4% 0.3 ml under conjunctiva No. 10, mildronate 10% 0.5 ml under the skin of the temple No. 10, mildronate 10% 4.0 ml v / m No. 8, emoxipin 1 % 2.0 ml IM No. 7, Cavinton 4.0 ml per 200 ml saline IV drip No. 3, Mexidol 5% 4.0 ml IM No. 5, retinalamine 0.5 ml parabulbarno No. 5, piracetam 20% 5.0 ml v / m No. 10.

Simultaneously with conservative treatment, transcranial electrical stimulation was performed on the TRANSAIR-05 apparatus using a pulsed bipolar current of 0.5-2.0 mA with modulation, while the first procedure set the current strength to 0.72 mA, with a subsequent increase in current at each the following procedure at 0.1-0.2 mA, given the condition of the patient. The duration of the procedure is 30 minutes, the course of treatment was 5 sessions. Visual acuity after treatment:

OD 0.5 with 0.6 correction

OS 1.0 without correction

Example 3

Patient Baranchikov V.A., 63 years old, medical history 193783-03, was treated at the NF FSI MNTK “Eye Microsurgery” from 01.06.07 to 06.14.07. Diagnosis: Primary open-angle glaucoma, simple stage 1 (initial) A. Initial senile cataract OD. Primary open-angle glaucoma simple stage 2 (developed) A operated. Initial senile cataract OS.

Visual acuity before treatment:

OD 0.4 with 1.0 correction

OS 0.1 with a correction of 0.75

The treatment of the claimed method. Conservative treatment included: taufon 4% 0.5 ml under conjunctiva, No. 10; Mildronate 10% 0.5 ml under the skin of the temple No. 5; Mildronate 10% 4.0 ml v / m No. 5; emoxypine 1% 2.0 ml v / m No. 7; Cavinton 2.0 ml per 200 ml of saline in / drip No. 5; Mexidol 5% 2.0 ml v / m No. 5; vitamin B ₆ 2.0 ml p / dermal No. 10; Cortexin 2.0 ml v / m No. 5; nicotinic acid 1% 2.0 ml v / m No. 10; ascorbic acid 5% 3.0 ml w / w No. 5; magnetophoresis with retinalamine 1 drop in both eyes before and after exposure to magnet No. 7.

Simultaneously with conservative treatment, transcranial electrical stimulation was performed on the TRANSAIR-05 apparatus using a pulsed bipolar current of 0.5-2.0 mA with modulation, while the first procedure set the current strength to 0.46 mA, with a subsequent increase in current strength at each the following procedure at 0.1-0.2 mA, given the condition of the patient. The duration of the procedure is 30 minutes, the course of treatment was 10 sessions. Visual acuity after treatment:

OD 0.6 with 0.1 correction

OS 0.3 with 0.8 correction

Using the proposed method will reduce the treatment time, increase the effectiveness of the treatment of vascular and dystrophic diseases of the eyes, as well as expand the functionality of the method. All patients emotionally positively perceived sessions of TES-therapy, noted improved sleep, decreased anxiety, improved mood.

Claims (3)

1. A method for the treatment of vascular and dystrophic diseases of the eyes, including the introduction of vasodilator drugs, characterized in that the introduction of 0.3-0.5 ml of 4% taufon under the conjunctiva, 7-10 times; 1-2 ml of 1% emoxipin / m, 7-10 times; 0.3-0.5 ml of 10% mildronate under the skin of the temple, 5-10 times; 4-5 ml of 10% mildronate IM, 5-8 times; 2-4 ml of cavinton per 200 ml of saline in / in, drip, 3-7 times; 2-4 ml of 5% Mexidol / m, 5-7 times; 0.5 ml of retinalamin parabulbarno, 5 times or 1 drop of retinalamin in both eyes before and after exposure to a magnet 7 times, and additionally carry out transcranial
electrical stimulation with a course of 6-7 sessions, starting with a current strength of 0.5-1.0 mA in the first session, followed by an increase in current strength of 0.1-0.2 mA, taking into account the patient's condition. 2. The method according to claim 1, characterized in that transcranial electrical stimulation is carried out on the apparatus "TRANSAIR-05". 3. The method according to claim 1, characterized in that as additional drugs use nootropics, metabolic and vitamin preparations selected from the group: piracetam 20% 5 ml, v / m, 10 times; Actovegin 5 ml, iv, 5 times; cortexin 2 ml, v / m, 5 times; vitamin B 6 2 ml, subcutaneously, 10 times; nicotinic acid 1%, 2 ml, v / m, 10 times; ascorbic acid 5%, 3 ml, iv, 5-7 times.